This post is contributed by the BUILD Technical Assistance team. Special thanks to them and the awardees who participated in this feature piece and who shared their insights with us.

As the second cohort of the BUILD Health Challenge (BUILD) is nearing the end of their award, many are actively working through plans for continuing the activities after the funding ends. (BUILD awardees are eligible to receive up to $250,000 in funding over two years from BUILD.) To share their experience and lessons learned, four representatives from the first cohort of BUILD (representing Ontario, Liberty City, Denver, and North Pasadena) participated on a webinar to share what they’ve been up to since their BUILD award ended, and how they’ve sustained the work post-funding. Many of their experiences and advice for awardees in the current cohort are applicable to efforts by communities, even those not a part of the BUILD cohort, that are working to drive sustainable improvements in community health.

Watch the full webinar here (click the play button to start the webinar).

Evette de Luca, President of The Social Impact Artists, and former project lead for the Healthy Ontario Initiative (HOI), talked about HOI’s process for sustainability planning. “For sustainability, we need to know where we came from, what we accomplished, and where we’re going,” said de Luca. HOI spent one year working on a sustainability process and came up with a document that articulated their plan with action steps, milestones, and voices from all partners and residents, to drive what sustainability would look like. De Luca said, “Intentional sustainability planning takes a lot of time, and is a heavy lift.” Putting together this document was critical to help them navigate choppy waters. When difficult decisions had to be made about which activities are maintained, having a sustainability plan in place that all partners weighed in and voted on made the decision-making process easier.

Ontario’s strategy to blend and braid resources also contributed to their ability to sustain the work. All partner organizations committed resources to all four of HOI’s key activities, and each partner takes turns to fund things. For example, clinical community health workers (CHWs) were initially supported by BUILD funds. In 2016, San Antonio Regional Hospital committed an additional $20,000 to sustain the CHWs. In 2018, the Department of Public Health took on the full financial sustainment, and from July 1, 2019 – June 2020, San Antonio Regional Hospital has committed financial resources to employ five clinical CHWs.

Reginald Young, Director of Food for Change and Partner Services at the Houston Food Bank, served as project lead for the Harris County BUILD Health Partnership. Young said, “You have to start thinking about sustainability at the beginning.” At the onset, the Harris County partnership created a sustainability committee to ensure sustainability was considered throughout all arms of the project. With the help of a consultant, they developed a plan to transfer most activities to community trustees so the work could continue to go forward after BUILD in a structure led by residents. They also considered each partner organization’s commitments. For example, the Houston Food Bank committed to continue providing food resources to one of the programs no matter where they expanded to. The Food Bank also expanded two other programs and raised funds to sustain those initiatives. Each partner organization made similar commitments, as did their executive leadership, so that community trustees could count on the partners to maintain their commitments. Community trustees were involved in the entire process, and were able to review, add, and approve the final plan. Read more about the Harris County Partnership in this BUILD Case Study.

Kellie Teter, Maternal Child Health Program Manager at Denver Public Health (DPH), was the health department lead for the Denver BUILD project called East5Unified. To plan for their continuation post-funding, East5Unified created three pillars of work:

  • Community Mobilization, Engagement, and Leadership
  • Continuous Learning and Evaluation
  • Anchor Institution Policy Change

Community Mobilization, Engagement, and Leadership recognizes that for the work to continue it has to be run by the community itself. They were awarded a health disparities grant from the Colorado Department of Public Health and Environment and are using an Assets Based Community Development (ABCD) Model as a community mobilizing strategy to support Anchor Institutions to improve their employment practices, procurement, and funding of community engagement.

Continuous learning and evaluation focused on collecting data and sharing it with the larger group. They took a non-traditional approach to data collection and display of data using mechanisms like storytelling, graphic design, graphic recording, videos, and photography.

Anchor Institution Policy Change meant convening large institutions to talk about how they can use their economic engine for good in the community. When three local museums applied jointly for an early childhood grant, and didn’t get the money, East5Unified asked if they were still interested in early childhood and what they would like to get out of participating. East5Unified has talked with these institutions about what it means to be an anchor and have worked to adopt a definition of an anchor institution.

Dr. Roderick King, Chief Executive Officer (CEO) for the Florida Institute for Health Innovation (formerly the Florida Public Health Institute), was the project lead for the Liberty City Community Collaborative for Change in Miami, Florida. Liberty City’s main challenge related to sustainability was building capacity to work together and to identify new funding streams to support their strategies. Many philanthropists were funding in silos, so they had to help funders think strategically about alignment together. BUILD gave them a chance to model how to do this in other communities. Now the Health Foundation has a healthier together initiative in two other cities, and Palm Healthcare in Palm Beach County is supporting two place-based-communities modeled after the Liberty City work.

Turnover in key leadership positions was also an issue Liberty City experienced, with the departure of the nonprofit CEO and the Department of Health Administrator shortly after the BUILD funding ended. Dr. King said, “When you change leadership, you have to make the case again for why this is a critical issue that the city needs to address. It takes time to rebuild a sense of urgency and reconnect with new leaders that come in.” In the past six months, both organizations have hired new leadership and partners are beginning to rebuild those relationships and promote understanding of the importance of continuing the work.

Communities secured funding from a variety of sources:

  • Liberty City was able to leverage dollars from the Health Foundation of South Florida and the Children’s Trust (a one-cent tax passed by the county to develop initiatives for children and families).
  • All of Ontario’s strategies will be sustained through 2020, and most will be sustained through 2025 due to a $35 million California Cap and Trade Funding Award.
  • Denver is currently operating on money from the Colorado Department of Health and the Environment (CDHE). CDHE’s Health Equity office put out a one-time opportunity to apply for a health disparities grant.
  • In addition to the blending and braiding of funds from partners to sustain different pieces of the work under the structure of the community trustees, Harris County received a grant from GE. MD Anderson Cancer Center (BUILD Hospital partner) secured additional funding from Shell Oil through an initiative called Pasadena vibrant communities.

Advice from the first cohort of awardees to the second:

  • Think about sustainability early and often. Look at how other large scale, complex collaboratives are sustaining this work and how can you model from them. Leverage BUILD alumni to help flesh things out going forward. Someone has probably encountered the same problem that you can learn from.
  • Document your process. Document whether you liked it or not, thought it was successful or not, and do so in creative ways so you can communicate it to others. You will forget and people want to know how you did something and how it happened. Nothing happened by accident.
  • Failures and mistakes happen. If you’re going to fail, fail fast, recoup, and get back on your feet. These are complex issues and communities and no one gets it right the first time. If you make a mistake, learn from it, share it with others, and get back on your feet.
  • Target three partners in your collaborative and have each of the three partners look at different funding opportunities or different corporate investments, and look at nontraditional players (e.g. oil company). Strategically pursue these opportunities together.

 

Interested in learning more? We encourage you to check out the “Getting BUILD Ready” guide on buildhealthchallenge.org/resources page where you can access more strategies BUILD sites have used related to sustainability and planning.

Have your own tips you want to share for sustainability? Please share them with us on Twitter by posting to @BUILD_Health.